Can Burn Centers Evacuate Safely in Response to Disasters?

Abstract

One of the U S's worst national disasters occurred on Monday August 29, 2005 as the Gulf Coast was hit by category 4 Hurricane Katrina. The storm was responsible for over 1000 deaths and the displacement of hundreds of thousands of people. New Orleans hospitals evacuated because of complete collapse of infrastructure. This event was influential in the decisions and actions taken to protect patients, families, and staff of a 30 bed pediatric burn center in the projected path of a second catastrophic Hurricane three weeks later. Approximately 80 hours before projected landfall, the local government announced that a mandatory evacuation of the community surrounding the burn center would occur. A coordinated decision was made by Administration, Nursing, and Medical Staff to cancel upcoming clinics and elective surgeries and evacuate the 14 inpatients, 52 outpatients and 66 guardians. The first group would include 6 critical care inpatients (average TBSA 70%, average age 6) who were to be transferred by medical jets to a sister pediatric burn care facility with equivalent capabilities. These children were followed to the same location by their guardians, four nursing staff and one faculty acute burn surgeon. The second group, non-critical inpatients and high acuity outpatients, numbered 12 children and 12 family members and were accompanied by 8 clinical care staff and one acute burn faculty member. This group was moved by ground transportation to children's orthopedic hospital, chosen for its proximity and affiliation with the primary hospital. The third group was made up of 25 outpatients, 25 guardians, 9 clinical care staff and a clinical burn fellow. All were evacuated via ground transportation to a university school of veterinary medicine. In addition, arrangements were made for 27 outpatients and their guardians to return to their homes. The above evacuation plan was completed by 32 hours following the decision for complete evacuation. The eye wall of the Hurricane passed 65 miles east of the burn center. No significant damage to the physical plant noted. The repopulation of the hospital by patients and acceptance of new acute burn referrals began approximately 40 hours after the all clear to return was given by the local government. No morbidity or mortality has been attributed to the evacuation. Planned evacuation of threatened burn centers can be safely accomplished with adequate prior planning of evacuation sites, modes of transportation and established communication command center.